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Resume Introduction. – L'atteinte pancreatique est une localisation exceptionnelle de la granulomatose de Wegener et merite d'etre signalee. Exegese. – Nous decrivons une observation d'une forme pseudo-tumorale de granulomatose de Wegener localisee au pancreas. Nous discutons six autres observations d'atteinte pancreatique rapportees dans la litterature medicale (deux pseudo-tumeurs, trois pancreatites aigues et une insuffisance pancreatique chronique). Conclusion. – C'est une localisation a ne pas meconnaitre d'autant plus qu'un traitement rapidement instaure et associant corticoides et cyclophosphamide semble efficace.

Resume Introduction De nombreuses localisations extrapulmonaires de la tuberculose ont ete decrites. La localisation linguale est rare et le plus frequemment secondaire a une atteinte pulmonaire ou plus rarement ganglionnaire. Observation Un homme de 64 ans, tabagique chronique souffrait d'une ulceration linguale chronique s'accompagnant d'une anorexie et d'une perte de poids importante. Une biopsie profonde de cette lesion a mis en evidence un granulome epithelioide et gigantocellulaire sans necrose caseeuse, sans bacille acido-alcooloresistant a l'examen direct. Les examens complementaires (radiographie thoracique, scanner thoracoabdominopelvien) montraient des signes de tuberculose disseminee confirmee par la positivite des cultures des prelevements pulmonaires, sanguins et urinaires. L'introduction d'un traitement anti-tuberculeux a permis la disparition rapide de l'ulceration linguale, evitant ainsi une evolution defavorable, voire fatale. Conclusion Une ulceration linguale d'origine tuberculeuse doit etre differenciee d'une lesion cancereuse, traumatique, d'un aphte ou d'un chancre syphilitique. Le diagnostic de l'origine tuberculeuse est difficile mais important a poser du fait de l'amelioration generalement rapide de la lesion apres introduction d'un traitement antituberculeux.

Tuberculous lesions of the oral cavity are uncommon. Most of cases are secondary to pulmonary disease and the primary form is rare.We report the case of a 64 year-old man, smoker, presenting a chronic ulcer of the tongue, with anorexia and important weight loss. The biopsy of this ulcer showed granulomatous inflammation and Langhans type giant cells, without necrosis. Ziehl-Nielsen stain was negative. Pulmonary lesions were subsequently detected (chest X-ray, CT-scan) and the disseminated tuberculosis was confirmed by a positive culture with acid-fast bacilli in urine, blood, and pulmonary sample. Antituberculosis treatment resulted in the complete resolution of the oral lesion.Biopsy for histopathological diagnosis, acid-fast stains and culture, is essential to determine the exact nature of chronic oral ulceration to distinguish between oral malignancy, infectious (syphilis), traumatic, or aphthous ulcers. Tuberculosis of the tongue is a difficult diagnosis. However it should be searched for because treatment usually results in a rapid recovery.

Pancreatic involvement in the course of wegener's granulomatosis is rarely reported.We report a case presenting as a pancreatic tumorlike lesion. We also discuss six further cases from the medical literature. Two of them had a tumorlike lesion, three had acute pancreatitis and the last had exocrine pancreatic insufficiency.Treatment, association of corticoid and cyclophosphamide, is efficient if it is started quickly. So we think that this unusual manifestation of Wegener's granulomatosis should be recognized.